International Journal of Basic & Clinical Pharmacology
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Sulfasalazine induced atypical drug reaction with eosinophilia and systemic symptoms syndrome: a case report
Get PDFDrug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a type IV b hypersensitivity reaction characterized by cutaneous manifestations, fever, lymphadenopathy, hematologic abnormalities, and multiple organ manifestations. We report a case of sulfasalazine induced DRESS syndrome who was admitted with a complaint of morbilliform rash all over the body, a fever of 100oF, and severe abdominal pain. Initially the patient did not mention about intake of sulfasalazine while taking the drug history as he could not remember the past medication. The laboratory investigations revealed elevated eosinophils, WBC, and liver function tests. The patient was treated with antibiotics assuming tropical infection, but the patient’s condition was not improving. Later while taking proper drug history from a patient representative over the telephone revealed that the patient was in 4th week of tablet sulfasalazine 500 mg treatment for polyarthritis. Further, the J-SCAR scale was used to diagnose it as Sulfasalazine induced atypical DRESS syndrome. The patient was treated with topical and intravenous corticosteroids and antihistamine; the patient exhibited surprising symptomatic improvement. The patient was given a tapering dose of oral corticosteroid tablet prednisolone 20 mg for three weeks and topical corticosteroid mometasone lotion for two weeks upon discharge
Antimicrobial stewardship program activities in India: an appraisal
Get PDFHuman antimicrobial misuse/overuse/irrational use is one of the main drivers of antimicrobial resistance (AMR) and in the presence of a rapidly drying up antibiotic pipeline, it becomes imperative that we learn to use antibiotics judiciously and responsibly. In 2010, India was adjudicated to be the world’s largest consumer of antibiotics and hence curbing injudicious use of antibiotics is a must. Antibiotic abuse happens due to common fallacies such as a belief that broad spectrum antibiotics are “safer” and failure to distinguish between bacterial infections and non-bacterial infections and non-infectious syndromes. In addition, antibiotics for durations longer than necessary, redundant cover (like double gram negative or double anaerobic cover) or treatment of colonizers or contaminants also constitute inappropriate antibiotic use. A stewardship program implementing rational antibiotic use is mandatory to curb irrational antibiotic use. Antimicrobial stewardship is defined as a set of coordinated interventions designed to measure and improve the appropriate use of antibiotics by promoting the selection of the optimal choice, dose, duration and route of the antibiotic which in turn lead to improved patient outcomes and decreased adverse effects
Evaluation of rationality of fixed dose combinations of antimicrobials available in Indian market
Get PDFBackground: The antimicrobial resistance is alarming at present. One of the important factors for resistance is use of irrational fixed dose combinations. Thus, objective was to critically analyze the rationality of FDCs of antimicrobial agents currently available in India.Methods: The FDCs of AMAs enlisted in Indian Drug Review 2019 were analyzed by 8 point criteria tool. Analysis includes number of active pharmacological ingredients, approval by central drug standard control organization, listing in world health organization model list of essential medicines (2019) or Government of India national list of essential medicines (2015). Literature search was used for assessing efficacy, safety, pharmacokinetic and pharmacodynamic interactions and advantages of each FDC. Each criterion was assigned score one, if positive and minus one, if negative leading to total score of 12. FDC with score of ≥7 was considered as rational. Results: The FDCs of AMA available in Indian market were 116 while FDCs included in WHO model list, 2019 were 24. Majority of FDCs available were irrational that include combination of antibacterial with bromhexine, carbocisteine, ambroxol, serratiopeptidase, antiamoebic and antifungal etc. Most of the rational FDCs belong to antiretroviral, antitubercular and antimalarial drugs. Conclusions: Most of the FDCs of AMAs available in Indian market are irrational. These needs educating the prescribers including resident doctors. There is need to critically review such FDCs by drug regulators with strict action regarding manufacturing and marketing
A drug utilization study of topical corticosteroids in the department of dermatology in a tertiary care teaching hospital in upper Assam
Get PDFBackground: Topical corticosteroids form an important group of drugs in dermatology and are among the most commonly prescribed medications. However, despite their efficacy, they are associated with various adverse effects and as majority of the skin conditions are chronic, there is a need to ensure that there is rationality in drug use. Thus, this study was conducted with an aim to analyze the drug utilization pattern of topical corticosteroids.Methods: The study was a hospital-based, prospective and observational study and conducted for a period of 12 months. The method of data collection was done based on one-on-one consultation with patients. Data collected were recorded prospectively in a specially designed proforma. Results were then entered and analyzed using Microsoft excel.Results: In the study, it was observed that 48% of the patients were males while 52% were females. Most patients belonged to the age group of 21-30 years (30%). Scabies (30%) was the most common dermatological condition. With regard to the prescribing frequency of different topical corticosteroids, mometasone furoate (31.4%) was the preferred choice in most patients. H1 antihistaminic drugs like levocetirizine (81.6%) were the most prescribed along with topical corticosteroids, followed by emollients (36.4%) and permethrin (29.2%). The average number of drugs per prescription was 3.6 and all drugs were prescribed by their generic names.Conclusions: Periodic monitoring of the drug utilization pattern in the form of prescription auditing is an effective tool to constitute guidelines for improving the utilization pattern
Inclusion body myositis in an older patient
Get PDFInclusion body myositis (IBM) is a condition also referred to as sporadic IBM. It is a rare variant of a broader group of diseases described under the banner of inflammatory myositis. In general, myositis/myositides tend to present with a varying cluster of symptoms such as muscular weakness, aches and/or pain. Myositis has been linked to multiple causes or triggers, but generally share the common feature (present to a variable extent) of inflammatory changes within skeletal muscle tissue. In addition, some associations (e.g. Sjogren’s disease and systemic lupus erythematosus – SLE) have been reported for IBM. Some medication classes (e.g. statins and fibrates) may present a risk to certain individuals developing drug-associated myopathies. IBM can be challenging to diagnose, and may be mistaken for many other causes of muscle weakness e.g. polymyositis. Furthermore, IBM tends to affect muscles asymmetrically, and runs a typically progressive and chronic course. Consequently, over time IBM may result in significant functional impairment, activity limitation, and participation restriction. This case report describes an older woman with a clinical diagnosis of probable IBM complicated with oesophageal dysmotility. She presented to hospital with progressive dysphagia, breathlessness, and a productive cough for which treatment was started for aspiration pneumonia. The report considers some broader ‘principles of management’ of a chronic myositis. In the current absence of a definitive curative treatment, we also discuss some realistic and practical pharmacological treatment options that may be used for the selective care of patients presenting with an incurable chronic myositis such as IBM
Investigation on the effectiveness of mouth-washing using laban leaves (Vitex pinnata) steeping water in reducing plaque accumulation: a study in state elementary school 1 Pagar Air, Aceh Besar
Get PDFBackground: Dental and oral diseases that are commonly suffered by Indonesian people, are dental caries and periodontal disease. Dental plaque is the primary cause of the periodontal disease and dental caries. The diseases can be prevented by inhibiting the formation of dental plaque using a mouthwash. One of the ways in removing dental plaque is by mouth washing using laban leaves (Vitex pinnata Linn) steeping water. Laban leaves contain alkaloids, flavonoids, saponins, and tannins which can inhibit the growth of Streptococcus mutans so that it capable of removing dental plaque naturally. Bio-ingredients have been long used in health sector for preventive, curative, and rehabilitative treatments.Methods: Experimental research with pre- and post-tests design using proposing sampling technique, where 56 people were taken as samples. The samples were divided into 2 groups which receiving different treatments. Group 1 was instructed to do mouth washing with laban leaves steeping water, while Group 2 was with water. Each of students did the mouth washing for 30 s (20 ml).Results: based on the comparison of the dental plaque index (before and after the mouth washing using laban leaves steeping water) it is revealed that the steeping water of laban leaves was effective in reducing the plaque index with p value of 0.000 (<α=0.05).Conclusions: mouth washing using the laban leaves steeping water was effective in reducing the plaque accumulation. We then recommend a further study to investigate the potential of laban leave to be used in a mouthwash.
Potential anticancer activity of some medicinal plants in vitro and in vivo study
Get PDFThe public health burden caused by cancer is significant in both developing and developed nations. The ability of biological, chemical, or synthetic substances to prevent, inhibit, or stop the progression of carcinogenic is known as anticancer activity. To treat the condition, several synthetic drugs are utilized, however because of their toxicity, research is now being done to examine chemotherapeutic medicines produced from plants. A review of several in vivo and in vitro techniques for determining the anticancer activities of natural compounds from medicinal plants has thus been undertaken. In this study, 50 Indian anticancer medicinal plants from 35 families are presented, together with comprehensive data on the parts and extracts utilized, the model type employed, the cancer cell line types that were tested, etc. These plants are still utilized to treat numerous tumor forms, including lymphoma, sarcoma, leukemia, and carcinoma. All of plants are likely candidates for in vivo research since they have strong anticancer action in vitro
Spinal anesthesia versus general anesthesia for percutaneous nephrolithotomy surgeries - a prospective study
Get PDFBackground: Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgery for extracting renal and urinary stones, and a choice modality in large, multiple, and stag-horn stones. Anaesthesia for PCNL can be general or regional. Despite good results of PNCL with general anaesthesia, it may cause atelectasis, drug reactions, nausea, and vomiting. General anaesthesia (GA) has its limitations in the form of poor postoperative pain control, greater incidence of nausea and vomiting, prolonged recovery stays and prolonged hospitalizations.Methods: The study was performed in a tertiary care centre. A prospective, randomised study including 60 patients divided into 2 groups. Data collection tools included study proforma, numerical rating scale (NRS) scores and visual analog scale (VAS) scores. Data analysed using science and statistical packaged (SPSS) version 21, independent t tests and z-test for proportion.Results: The demographic data when statistically analysed showed no statistically significant differences between the groups. Haemoglobin percentage (Hb%) was significantly lower in GA group. Spinal anaesthesia (SA) group showed lower VAS and NRS scores hence lower requirement of pain relief and antiemetics. The post-operative complications were insignificant.Conclusions: We concluded that SA is safe and effective method as an alternative method for PCNL surgeries.
An audit of prescriptions in general medicine outpatient department in a tertiary care government hospital in Eastern India: a quality improvement project
Get PDFBackground: Prescriptions are an important link between physicians and patients. Any medication therapy can become ineffective if not communicated properly to the pharmacist and patient. Therefore, it’s important to maintain the quality of prescription-writing. Thus, we conducted a prescription audit in a tertiary-care hospital.Methods: 413 prescriptions having 1683 drugs were selected by convenience sampling. Adherence to 4 quality parameters, namely mention of date, allergy status, date of next visit, and whether or not the prescription was signed legibly, were observed for each prescription. 5 parameters viz. whether or not the drug was written in capital letters, whether the generic name of the drug was mentioned, and prescription of drug schedule, dose, and duration were evaluated for each drug separately. Frequency tables and appropriate bar plots were created.Results: Dates were mentioned in all prescriptions. There were 4.07±0.44 (mean±SD) drugs per prescription. Using capital letters and generic names was observed for 12% and 21% of the drugs. Dose, duration, and schedule were written for 51.4%, 98.6% & 98.7% drugs respectively. The next visit was mentioned in 61.7% cases. 21.8% prescriptions were signed legibly and only 0.5% prescriptions had allergy status.Conclusions: A significant scope of improvement was observed in signing the prescription legibly, mentioning next visit, using generic names, writing the drug names in capital letters, drug doses, and mentioning allergy status. Conducting regular audit-feedback-audit loops will improve the quality of health care delivery in a practical manner.
The role of honey in the treatment of type 2 diabetes mellitus: a review of literature
Get PDFThe use of honey in the control of hyperglycemia in patients with type 2 diabetes mellitus is a current option being explored globally. Honey bees which are named in Latin as Apis, use the collected nectar from plants to produce honey after regurgitation and digestion of nectar. Carbohydrate constitutes about 80% of the components of honey. It includes monosaccharides [fructose (37.5%) and glucose (30.6%), disaccharides (sucrose (1.6%) and maltose (2.7%)] and oligosaccharides. Natural honey also contains water (17.2%), proteins, vitamins, minerals, enzymes, acids such as flavonoids, phenolic acids and other components. Honey is rich in antioxidant content and these antioxidant compounds function as endogenous cellular antioxidant defences against free radicals in diabetes mellitus. Antioxidants have also been shown to exert a beneficial effects on blood glucose. Fructose and other bioactive constituents of honey have also been linked with amelioration of hyperglycemia. Besides the beneficial effects of honey on blood glucose, honey is widely used in the management of diabetic foot ulcers, an important complication of diabetes mellitus. The wound-healing benefits of honey are attributed to its antioxidant constituents and broad-spectrum antimicrobial activity. Though additional studies are needed, the use of honey in the management of diabetes mellitus holds much promise